Reform, not improvement - article for Campaign Group
News, October 2003.
recently received the formal consultation document from University Hospital
Trust in Birmingham about their bid to achieve foundation status. In it they say
this change will enable them to involve and serve local people better because decisions
will be made locally rather than in Whitehall. Yet they are not putting the
principle of becoming a foundation trust to local people (click here
for info on adding your view). That is a fait accompli that calls into question the
Trusts commitment to real accountability, as do the remarks at a conference of the
Chair of the Trust, reported in the Health Services Journal. I am in favour
of foundation trusts he said essentially to get certain people off our backs.
Yes, let's have autonomy, lets have accountability, but for goodness sake don't
expect us to have a 5,000 strong membership. That would be an absolute nightmare.....We
have a huge private finance scheme and I want him (referring to the Chief Executive)
concentrating on that. I don't want him spending all his time out recruiting members of
the local co-op.
these comments, the consultation conforms to Government requirements and includes an
application for membership with the promise of exciting benefits such as attendance at
seminars and access to a members-only website. It is true that members will be able
to elect half of the Foundation Trusts Board of Governors (others will be appointed
by "stakeholders") who will have some say in the selection process for
non-executive directors and, through them, the appointment of executive directors.
However, the current directors have devised a system that will enable them to
retain their influence for many years to come. And if the Trust does achieve the
nightmare of 5000 members or even a few more, they will be no more
representative of the 400,000 people for whom the Trust is the district general hospital,
let alone the 4 million who look to the Trust for specialist services, than are existing
consultative arrangements involving four patients councils.
want those responsible for running pubic services to be genuinely accountable to the
people they serve, this can only be done through elections in which everyone has a vote
and the people they elect have real power. The governance arrangements for
foundation trusts do not begin to meet these requirements. Furthermore it is also
misleading to suggest that foundation trusts will be free of control from Whitehall.
Foundation trusts will be subject to a Whitehall-appointed regulator and, like
other hospitals, they will be inspected by the Government-appointed Commission for
Healthcare Audit and Inspection. All hospital trusts, foundation or otherwise, are
subject to legally-binding agreements with primary care trusts (PCTs) that are themselves
subject to a range of Government targets, which affect what services they commission.
Ultimately, if a foundation trust fails to meet Government standards, the
Government will be able to remove its foundation status.
hospitals will do nothing to improve accountability in the NHS. Their development,
together with the decision to commission diagnostic and treatment centres from the private
sector rather than building up NHS capacity, plays into the hands of the Tories who must
be having a good laugh at the associated decision to abandon our pledge to abolish the
internal market and instead to re-create their system whereby money follows the
patient. Should we ever be unfortunate to have to suffer another Tory
Government, we will have handed them a blue-print to privatise and fragment the NHS.
If we really believe in decentralisation we should be planning to hand over health
services to regional government. Meanwhile, the most obvious unit of accountability
would be through PCTs which commission and pay for services for a specific catchment area.
These bodies also provide primary care and community services and were conceived as
being pivotal in developing a primary care-led NHS. Foundation trusts undermine this
concept, again demonstrating the Governments inconsistent and illogical approach
which seems mainly designed to win approval from the likes of the Daily Mail. When
will the Leadership of our Party realise that reform is not the same as improvement?